Hyperhidrosis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Hyperhidrosis is an excess sweating condition beyond physiologic need.
Classified as primary and of unknown cause (idiopathic), or secondary due to an underlying condition (usually an infectious, endocrine, or neurologic disorder).
Primary hyperhidrosis may also be described as palmar, plantar, axillary, and craniofacial, each of which has its own clinical characteristics. Patients may have a combination of anatomic areas affected.
Primary hyperhidrosis occurs in both adults and children, commonly starting in early childhood or at puberty.
Treatment options for primary hyperhidrosis include medical and surgical treatments. Medical treatments include topical aluminum chloride, oral anticholinergic agents, iontophoresis, onabotulinumtoxinA (botulinum toxin type A) injections, microwave ablation, and targeted alkali thermolysis. Surgical treatments include direct axillary sweat gland removal and thoracoscopic sympathectomy.

Profound sweating provoked in a patient with palmoplantar hyperhidrosis after administration of a small amount of hand lotion

From the personal collection of Fritz Baumgartner, MD

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Schematic drawing showing the relationship of the central nervous system to the sympathetic ganglia and peripheral and visceral targets
Profound sweating provoked in a patient with palmoplantar hyperhidrosis after administration of a small amount of hand lotion
Thoracoscopic view of the left upper posterior mediastinum with the sympathetic chain visualized over the 2nd, 3rd, and 4th costal heads (R2, R3, and R4, respectively)
Thoracoscopic view of the right upper posterior mediastinum with the sympathetic chain visualized over the 2nd and 3rd rib costal heads (R2 and R3, respectively). Transection of the sympathetic chain at the level of T2 on the right and left sides is curative for palmar hyperhidrosis

Citations

Key Articles

International Hyperhidrosis Society. Clinical guidelines. 2018 [internet publication].[Full Text]
International Hyperhidrosis Society. Diagnosis guidelines. 2018 [internet publication].[Full Text]
Baumgartner FJ. Surgical approaches and techniques in the management of severe hyperhidrosis. Thorac Surg Clin. 2008 May;18(2):167-81.[Abstract]
McConaghy JR, Fosselman D. Hyperhidrosis: management options. Am Fam Physician. 2018 Jun 1;97(11):729-34.[Abstract][Full Text]
Cerfolio RJ, De Campos JR, Bryant AS, et al. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg. 2011 May;91(5):1642-8.[Abstract][Full Text]

Other Online Resources

American Academy of Family Physicians: excessive sweating (hyperhidrosis)
British Association of Dermatologists: hyperhidrosis

Referenced Articles

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